PRIOR PRINTER'S NO. 579

PRINTER'S NO. 2284

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

564

Session of

2019

INTRODUCED BY SAYLOR, RYAN, BARRAR, JAMES, READSHAW, BERNSTINE,

MURT, ROTHMAN, MILLARD, McNEILL, B. MILLER, LAWRENCE,

WHEELAND, ZIMMERMAN, KAUFFMAN, GOODMAN, CIRESI, JONES, HILL-

Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An

act relating to insurance; amending, revising, and

consolidating the law providing for the incorporation of

insurance companies, and the regulation, supervision, and

protection of home and foreign insurance companies, Lloyds

associations, reciprocal and inter-insurance exchanges, and

fire insurance rating bureaus, and the regulation and

supervision of insurance carried by such companies,

associations, and exchanges, including insurance carried by

the State Workmen's Insurance Fund; providing penalties; and

Section 1. Section 1202 2166 of the act of May 17, 1921

(P.L.682, No.284), known as The Insurance Company Law of 1921,

is amended to read:

Section 1202. Forms for Health Insurance Claims.--(a) Each

health insurance claim form processed or otherwise used by an

insurer, including those used by the Department of [Public

the feasibility of utilizing the UB-82/HCFA-1450 and HCFA-1500

forms, or their successors, as a uniform claim form. If these

forms are deemed to be unsatisfactory, the department shall, in

consultation with the Department of [Public Welfare] Human

Services, insurers and health care providers or their

representatives, develop a uniform claim form for use by all

insurers, the Department of [Public Welfare's] Human Services'

public health care coverage program and health care providers.

The uniform claim form shall contain blank spaces at appropriate

places in the document for approved additional information

required to use the uniform claim form within one hundred twenty

(120) days after the uniform claim form is developed. The

department may consider a request from the Department of [Public

Welfare] Human Services for an extension in meeting the

implementation schedule of this section.

(c) (1) Subject to the procedure contained in clause (2),

an insurer may request that a claimant provide departmentally

approved additional information which is not requested on the

disapproved within sixty (60) days after receipt of the request.

A disapproval shall be subject to the procedures under 2 Pa.C.S.

(relating to administrative law and procedure).

(3) If, in a dental claim form, an insured specifically

authorizes payment of benefits directly to an entity or person

who provided dental services in accordance with the provisions

of the policy, the insurer shall make the payment to the

specific provider of the dental services. The insurance contract

may not prohibit, and claim forms must provide an option for,

the payment of benefits directly to the specified provider of

case of supplemental major medical claim forms, utilization of

the uniform claim form shall be at the discretion of the

individual insurer.

(e) (1) The Legislative Budget and Finance Committee shall

conduct a study to examine all of the following:

nonparticipating providers by health insurance carriers on a

health insurance carrier's ability to maintain an adequate

number of providers in the health insurance carrier's network.

(2) A report on the study under clause (1) shall be

presented to the chairperson and minority chairperson of the

Banking and Insurance Committee of the Senate and the

chairperson and minority chairperson of the Insurance Committee

of the House of Representatives no later than thirty-six (36)

months after the effective date of this subsection.

SECTION 2166. PROMPT PAYMENT OF CLAIMS.--(A) A LICENSED

TEN PER CENTUM (10%) PER ANNUM SHALL BE ADDED TO THE AMOUNT OWED

ON THE CLEAN CLAIM. INTEREST SHALL BE CALCULATED BEGINNING THE

DAY AFTER THE REQUIRED PAYMENT DATE AND ENDING ON THE DATE THE

CLAIM IS PAID. THE LICENSED INSURER OR MANAGED CARE PLAN SHALL

NOT BE REQUIRED TO PAY ANY INTEREST CALCULATED TO BE LESS THAN

TWO ($2) DOLLARS.

(C) FOR PURPOSES OF THIS SECTION, A CLAIM SHALL BE DEEMED TO

BE PAID WHEN A LICENSED INSURER OR MANAGED CARE PLAN:

(1) MAILS A CHECK TO THE PARTICIPATING HEALTH CARE PROVIDER

OR NONPARTICIPATING HEALTH CARE PROVIDER; OR